21,3" Gomez et al.: Early Lesions of Leprosy 245 
nodules appear; and that, with the exception of two cases (FS. 
and J.C.), when macular lesions (usually whitish) coexist with 
other lesions, the former appear first; in four cases there were 
no macular patches and in two of these (J.R. and A.C.) anzs- 
thesia preceded the nodules, in one there were infiltration and 
anesthesia, and in another only nodules. 
The early lesion and the development of leprosy are also illus- 
trated by the following records of children who are bacteriolog- 
ically positive lepers: 
I—C.B. (Table 3, No. 1), Filipino, 3 years old, male. Born in Culion. 
Father nonleper, living outside. The mother and maternal grandfather are 
lepers living in Culion. One sister 15 years old, one brother 13 years 
old, and one sister 8 years old are nonlepers living outside. 
He has been living since birth within the leper population. In June, 
1921, this child was negative physically and bacteriologically. In February, 
1922, he showed several white areas on the left cheek, right loin, right 
buttock, external surface of right thigh, posterior surface of left thigh, 
posterior surface of right arm, ulnar side of right forearm, and back of 
left arm, and two slightly elevated areas on the surface of the left thigh. 
There was one white area on the anterior surface of the left forearm which 
showed an elevated, infiltrated, distinctly red center (Plate 5, fig. 1). 
The skin of both legs -was flushed. There was no anesthesia. There were 
some scars due to scabies. The nose was negative on physical examination. 
According to the mother the first spot that appeared was the one on 
the left cheek, about eight months ago; three months later the area on 
the right buttock and the rest of the patches appeared in rapid succession, 
practically at the same time. The reddening and infiltration of the 
center of the white patch on the left forearm was noticed only about one 
month ago. 
The bacteriological examination in February, 1922, showed bacilli in 
the white patches, but much more numerous in the red center of the area 
of the left forearm. ‘The nasal septum was bacteriologically negative. 
Il—G.D. (Table 3, No. 6), Filipino, 5 years old, female, born in 
Culion in 1916. Both parents lepers, mother dead, father alive and residing 
in the Culion Leper Colony. One sister, 8., nonleper, was sent away from 
Culion; another, L., 4 years old, now in Culion, has suspicious lesions 
which are bacteriologically negative. 
G. was isolated in the Negative Children’s House at the age of 1 
year and 6 months, and was discharged two and a half years later, on 
account of the development of white nonanzsthetic areas, suspicious of 
leprosy. In June, 1921, she showed whitish areas all over the body and 
flushed, shiny, scaly legs; the white areas and the nose were bacterio- 
logically negative. In September and November, 1921, the patches remained 
about the same (Plate 4, fig. 1), the scrapings from the spots and from the 
nose were still negative for B. leprx; injection of 0.001 gram pilocarpine 
nitrate and administration of hot tea failed to elicit sweating in the white 
areas, 
In February, 1922, the white areas all over the body showed reddish 
elevated borders (Plate 5, fig. 3), the face was reddish, and there were 
sma]] nodules on both ears. The legs were still flushed and scaly. The 
